Advancement in microsurgical management of unruptured intracranial vertebral artery fusiform aneurysms: indications, techniques, and outcomes focusing on the integrity of vertebral artery and medullary perforators

Microsurgical management of unruptured VAFAs, guided by a novel Mperf classification and a tailored surgical algorithm, was found to achieve excellent and durable results. The authors emphasize the importance of a thorough intraoperative Mperf evaluation and keep perforator-preserving techniques in mind, including strategic clipping and perforator bypass, to minimize the risk of MI. This study highlights the essential role of microsurgery in the contemporary management of complex posterior circulation aneurysms.